Around half of all Americans who are over the age of 18 will suffer an injury lasting more than three months. In many cases, these people will need physical therapy. This might include in-home physical therapy, or it can be somewhere like a hospital or medical office setting.
Physical therapy is also known as PT. A trained professional evaluate a patient and then, as needed, treats abnormal physical function that relates to an injury or disability, or some other health condition.
The American Physical Therapy Association describes physical therapists as trained, licensed movement experts. They can help improve range of movement and quality of life for patients, reducing further injury or disability.
The following is a guide to what to know about physical therapy and what you might expect.
An Overview
Physical therapy is a specialty of healthcare. The specialty includes evaluating, assessing, and treating people with limited mobility. These services are provided by professional physical therapists who are licensed in the state they practice.
Also known as a PT, a physical therapist is required to have a master’s degree or a clinical doctorate degree. They also have to pass their licensing exam. A physical therapist who already practices and just has a master’s degree can continue to do so, but the newer guideline for students is that they’re required to get a doctorate degree going forward.
If you’re hurt, or you have an illness that affects your movement or function or causes pain or impairment, you may need physical therapy. Some PTs will specialize in certain age groups, like children or the elderly.
Some of the many conditions that a physical therapist might treat include:
- Foot and ankle injuries
- Hip conditions such as hip fractures
- Joint replacement recovery
- Shoulder conditions
- Post-operative cancer care
- Sports injuries
- Conditions of the spine
- Sports performance
- Treatments for the pelvic floor
- Osteoporosis
- Cardiopulmonary conditions like COPD or cystic fibrosis
- Lymphedema
- Urinary incontinence
- Skin conditions or injuries like burns or wound care
- Neurological conditions such as traumatic brain injuries, Parkinson’s disease, multiple sclerosis, or stroke
Benefits of physical therapy, some of which have been touched on, include:
- Pain management and reduced need for opioids
- Reducing the likelihood of needing surgery
- Better movement and mobility
- Help with recovery from injury, trauma, stroke, or paralysis
- Prevent falls
- Better balance
- Management of medical problems related to aging
Do You Need A Referral?
One frequent question people have is whether they need a referral for physical therapy or whether a provider will accept direct access patients. There are different factors playing a part in whether you need a referral or prescription from your primary care doctor, including the law in your state and your insurance policy.
All 50 states, and the District of Columbia, have approved physical therapy direct access, which means you don’t need to go to a doctor first. There are some restrictions, though. Some states will put restrictions on specific treatments or how long you can go to physical therapy, for example.
Around 20 states have unrestricted laws for direct access, meaning patients can schedule a physical therapy appointment at any time.
Some insurance policies can require a referral, though, so you need to check with your provider.
To find a physical therapist, you’ll want to think about whether they accept your insurance if they have an area of specialty, their geographic location, and your reason for needing treatment. Insurance companies will typically be able to provide you with a list of therapists that participate in certain plans. You can also ask for a recommendation from a health care provider, even if you don’t need an actual referral.
Does Insurance Cover Physical Therapy?
The costs of physical therapy can add up quickly. You’ll probably need more than one session, and treatment may last for weeks or months. You have to pay for each treatment, and even if your health plan covers your PT, you may be responsible for a copay and coinsurance.
A lot of patients need as many as 36 sessions to get proper movement after something like rotator cuff surgery.
Many plans will cover physical therapy, but for coverage to apply, the sessions would have to be an essential benefit. An essential benefit might include wellness and preventative services, management of a chronic condition, or rehabilitative or habilitative services. If you have therapy that’s not considered an essential benefit, it may not be covered. You need to talk to your health insurance provider before you get any PT.
Your insurance company may tell you one of three things. They may tell you that PT isn’t covered, in which case you pay the rate set by your insurer with the physical therapist. If your health insurance provider says PT is covered, your insurer pays a percentage of your bill, which is coinsurance. If your physical therapy is covered, you’ll pay a copay, which is a flat fee for your visit.
Sometimes PT might be considered preventative. For example, if you’re a senior and you’re going to PT to reduce the likelihood of a fall, this might count as preventative care.
What About In-Home Physical Therapy?
Some people may opt for in-home physical therapy, but the availability and cost of in-home physical therapy depend on many of the same factors above, like your insurance coverage.
If you have a physical issue that would make it a burden to travel for PT, you might qualify for in-home treatment. A physician typically refers patients for in-home physical therapy when they think they would benefit but would have trouble getting to and from appointments.
Original Medicare will also cover outpatient therapy if there’s a medical necessity. Typically, there’s 80% coverage for these types of services. Medicaid will cover specialized therapy in your home if it’s medically necessary for some states, but not all states cover these services in-home or even in the community.
Physical therapy can be extremely beneficial for a wide variety of conditions, injuries, and disabilities. If you think it might benefit you or your loved one, you might want to speak with your health care provider or insurance company.
